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Subclinical (asymptomatic) parasitemia is very common amongstPlasmodium-infected individuals. The immunological mechanisms underlying subclinical parasitemia remain elusive. We investigated the immune regulatory mechanisms behind chronic asymptomaticPlasmodiuminfection using mice lacking humoral immunity (µMT−/−mice). µMT−/−mice became chronically infected, despite lacking outward signs of disease, and exhibited increased macrophage numbers, decreased dendritic and CD4 cells, massive hemozoin accumulation in the spleen and bone marrow, and inadequate hematopoiesis. These changes were accompanied by high circulating levels of interleukin-10 (IL-10), enhanced chromatin accessibility of the STAT3 promoter, and enhanced STAT3 binding to the IL-10 promoter in macrophages. Inhibition of IL-10 signaling, despite promoting parasite clearance, resulted in a proinflammatory response, weight loss, and mortality. These results suggest that epigenetic changes induced by chronicP. chabaudiinfection lead to high levels of circulating IL-10, protecting chronically infected mice against an excessive inflammatory response to high levels of blood-stage parasites.Author summaryMalaria is a life-threatening disease with a range of symptoms, and it is induced in humans by infections with different species ofPlasmodium. Highly prevalent in endemic regions, asymptomaticPlasmodiuminfections are related to long-term exposure to the parasite due to multiple infections and have been demonstrated in human and mouse studies to be associated with elevated levels of IL-10. However, how IL-10 levels remain elevated in the circulation in individuals over the long term has not been determined. We used a mouse model of chronic asymptomaticPlasmodiuminfection to investigate the mechanisms by which IL-10 levels are elevated during chronic asymptomatic infection. Our results show that epigenetic changes in immune genes of myeloid origin could be responsible for the elevated levels of IL-10, and that IL-10 signaling protected chronically infected mice from a severe inflammatory response induced by the infection.

Genome‐wide analysis of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) strains is essential to better understand infectivity and virulence and to track coronavirus disease 2019 (COVID‐19) cases and outbreaks. We performed whole‐genome sequencing of 27 SARS‐CoV‐2 strains isolated between January 2020 and April 2020. A total of 54 mutations in different genomic regions was found. The D614G mutation, first detected in March 2020, was identified in 18 strains and was more likely associated with a lower cycle threshold (

Purpose Patients undergoing prophylactic central compartment dissection (PCLND) for papillary thyroid cancer (PTC) are often overtreated. This study aimed to determine if molecular fluorescence-guided imaging (MFGI) and spectroscopy can be useful for detecting PTC nodal metastases (NM) and to identify negative central compartments intraoperatively. Methods We used a data-driven prioritization strategy based on transcriptomic profiles of 97 primary PTCs and 80 normal thyroid tissues (NTT) to identify tumor-specific antigens for a clinically available near-infrared fluorescent tracer. Protein expression of the top prioritized antigen was immunohistochemically validated with a tissue microarray containing primary PTC (n = 741) and NTT (n = 108). Staining intensity was correlated with 10-year locoregional recurrence-free survival (LRFS). A phase 1 study (NCT03470259) with EMI-137, targeting MET, was conducted to evaluate safety, optimal dosage for detecting PTC NM with MFGI, feasibility of NM detection with quantitative fiber-optic spectroscopy, and selective binding of EMI-137 for MET. Results MET was selected as the most promising antigen. A worse LRFS was observed in patients with positive versus negative MET staining (81.9% versus 93.2%; p = 0.02). In 19 patients, no adverse events related to EMI-137 occurred. 0.13 mg/kg EMI-137 was selected as optimal dosage for differentiating NM from normal lymph nodes using MFGI (p p Conclusion MET is overexpressed in PTC and associated with increased locoregional recurrence rates. Perioperative administration of EMI-137 is safe and facilitates NM detection using MFGI and spectroscopy, potentially reducing the number of negative PCLNDs with more than 25%. Clinical trial registration. NCT03470259.

Although the existing flu vaccines elicit strong antigen-specific antibody responses, they fail to provide effective, long term protection – partly due to the absence of robust cellular memory immunity. We hypothesized that co-administration of combination adjuvants, mirroring the flu-virus related innate signaling pathways, could elicit strong cellular immunity. Here, we show that the small molecule adjuvant R848 and the RNA adjuvant PUUC, targeting endosomal TLR7s and cytoplasmic RLRs respectively, when delivered together in polymer nanoparticles (NP), elicits a broadened immune responses in mouse bone marrow-derived dendritic cells (mBMDCs) and a synergistic response in both mouse and human plasmacytoid dendritic cells (pDCs). In mBMDCs, NP-R848-PUUC induced both NF-κB and interferon signaling. Interferon responses to co-delivered R848 and PUUC were additive in human peripheral blood mononuclear cells (PBMCs) and synergistic in human FLT3-differentiated mBMDCs and CAL-1 pDCs. Vaccination with NPs loaded with H1N1 Flu antigen, R848, and PUUC increased percentage of CD8+ T-cells in the lungs, percentage of antigen-specific CD4-T-cells in the spleen, and enhanced overall cytokine-secreting T cell percentages upon antigen restimulation. Also, in the spleen, T lymphopenia, especially after in vitro restimulation with dual adjuvants, was observed, indicating highly antigen-reactive T cells. Our results demonstrate that simultaneous engagement of TLR7 and RIG-I pathways using particulate carriers is a potential approach to improve cellular immunity in flu vaccination.

Simultaneous monitoring of electrocardiogram (ECG) and electroencephalogram (EEG) in studied animal models requires innovative engineering techniques that can capture minute physiological changes. However, this is often administered with a bulky and/or invasive system that may cause discomfort to animals and signal distortions. Here, we develop an integrated bioelectronic sensing system to provide simultaneous recordings of ECG and EEG in real-time for Xenopus laevis. The microelectrode array (MEA) membrane and the distinct anatomy of Xenopus offer noninvasive multi-modal electrophysiological monitoring with favorable spatial resolution. The system was validated under different environmental conditions, including drug exposure and temperature changes. Under the exposure of Pentylenetetrazol (PTZ), an epilepsy-inducing drug, clear ECG and EEG alterations, including frequent ictal and interictal EEG events, 30 dB average EEG amplitude elevations, abnormal ECG morphology, and heart rate changes, were observed. Furthermore, the ECG and EEG were monitored and analyzed under different temperatures. A decrease in relative power of delta band was observed when cold environment was brought about, in contrast to an increase in relative power of other higher frequency bands while the ECG remained stable. Overall, the real-time electrophysiology monitoring system using the Xenopus model holds potential for many applications in drug screening and remote environmental monitoring.

Proceedings from the 4th European Summer School on Nutrigenomics (ESSN 2021); 2021 Jun 21-25; Online. Basel: S Karger AG; 2021. p. 13. (Lifestyle Genomics)

IntroductionThe global prevalence of chronic obstructive pulmonary disease (COPD) is increasing, and it has become a major public health burden worldwide, including in Vietnam. A large body of preclinical and clinical studies supports the safety of mesenchymal stem/stromal cells (MSCs) in the treatment of lung injury, including COPD. The aim of this trial is to investigate the safety and potential therapeutic efficacy of allogeneic administration of umbilical cord-derived MSCs (UC-MSCs) as a supplementary intervention in combination with standard COPD medication treatments in patients with moderate-to-severe COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 and Vietnam Ministry of Health’s guidelines.Methods and analysisThis matched case–control phase I/II trial is conducted at Vinmec Times City International Hospital, Hanoi, Vietnam between June 2020 and December 2021. In this study, 40 patients will be enrolled and assigned into two age-matched, gender-matched and COPD condition-matched groups, including a UC-MSC group and a control group. Both groups will receive standard COPD medication treatment based on the GOLD 2019 guidelines and the Vietnam Ministry of Health protocol. The UC-MSC group will receive two doses of thawed UC-MSC product with an intervention interval of 3 months. The primary outcome measures will include the incidence of prespecified administration-associated adverse events and serious adverse events. The efficacy will be evaluated based on the absolute changes in the number of admissions, arterial blood gas analysis, lung function and lung fibrosis via CT scan and chest X-ray. The clinical evaluation will be conducted at baseline and 3, 6 and 12 months postintervention.Ethics and disseminationEthical approval was secured from the Ethical Committee of Vinmec International Hospital (number:166/2019/QĐ-VMEC) and Vietnam Ministry of Health (number:2002/QĐ-BYT). The results will be reported to trial collaborators, publication in peer-reviewed academic journals.Trial registration numberNCT04433104.

Injection drug use and heterosexual transmission from male key populations to their female partners have been the dominant modes of HIV transmission in Vietnam. A demonstration project was conducted to offer immediate antiretroviral therapy (ART) (regardless of CD4 cell count) to HIV-seropositive partners in serodiscordant couples. During March–December 2013, couples HIV testing and counselling (HTC) and immediate ART were offered in two drug use-affected provinces. Of 256 couples receiving couples HTC, 146 (57%) were serodiscordant; 134 (92%) seropositive partners initiated ART irrespective of CD4 cell count. Of these, 86% were male; 57% reported ever using illicit drugs; median CD4 cell count before ART initiation was 374 cells/mm3. Consistent condom use was reported by 58, 70 and 71% among HIV-positive partners at months 0, 3 and 12. At 12 months after ART initiation, 119 (89%) HIV-positive partners were retained in care; 96 (95% of those tested) achieved viral suppression (

Objectives This study was conducted in order to evaluate the effect of geometric distortion (GD) on MRI lung volume quantification and evaluate available manual, semi-automated, and fully automated methods for lung segmentation. Methods A phantom was scanned with MRI and CT. GD was quantified as the difference in phantom’s volume between MRI and CT, with CT as gold standard. Dice scores were used to measure overlap in shapes. Furthermore, 11 subjects from a prospective population-based cohort study each underwent four chest MRI acquisitions. The resulting 44 MRI scans with 2D and 3D Gradwarp were used to test five segmentation methods. Intraclass correlation coefficient, Bland–Altman plots, Wilcoxon, Mann–Whitney U, and paired t tests were used for statistics. Results Using phantoms, volume differences between CT and MRI varied according to MRI positions and 2D and 3D Gradwarp correction. With the phantom located at the isocenter, MRI overestimated the volume relative to CT by 5.56 ± 1.16 to 6.99 ± 0.22% with body and torso coils, respectively. Higher Dice scores and smaller intraobject differences were found for 3D Gradwarp MR images. In subjects, semi-automated and fully automated segmentation tools showed high agreement with manual segmentations (ICC = 0.971–0.993 for end-inspiratory scans; ICC = 0.992–0.995 for end-expiratory scans). Manual segmentation time per scan was approximately 3–4 h and 2–3 min for fully automated methods. Conclusions Volume overestimation of MRI due to GD can be quantified. Semi-automated and fully automated segmentation methods allow accurate, reproducible, and fast lung volume quantification. Chest MRI can be a valid radiation-free imaging modality for lung segmentation and volume quantification in large cohort studies. Key Points • Geometric distortion varies according to MRI setting and patient positioning. • Automated segmentation methods allow fast and accurate lung volume quantification. • MRI is a valid radiation-free alternative to CT for quantitative data analysis. Electronic supplementary material The online version of this article (10.1007/s00330-018-5863-7) contains supplementary material, which is available to authorized users.

A 25-year-old man presented with a 2-month history of progressively worsening left eye pain and an atypical corneal ring infiltrate. His condition deteriorated despite topical antibiotic therapy. Cultures for bacteria, fungus and acanthamoeba, repeated twice, all demonstrated no growth. On third corneal scraping, culture on Middlebrook agar grew colonies after 3 weeks of incubation. Sixteen-second deep sequencing identifiedNocardia sienataas the pathogen. This species of Nocardia has not previously been described as a causative pathogen for infectious keratitis. Sloughing and loose epithelium with recurrent filament formation are unusual in infectious keratitis and could be associated with this species. In culture-negative cases, clinicians should consider Nocardia as a cause of keratitis despite its rarity outside of south Asia and use steroids cautiously. Next generation sequencing technology may facilitate identification of the causate of keratitis and can be especially useful in culture-negative cases and with unexpected pathogens.

The understanding of the formation of silicate oligomers in the initial stage of zeolite synthesis is important. The use of organic structure-directing agents (OSDAs) is known to be a key factor in the formation of different silicate species and the final zeolite structure. For example, tetraethylammonium ion (TEA+) is a commonly used organic template for zeolite synthesis. In this study, ab initio molecular dynamics (AIMD) simulation is used to provide an understanding of the role of TEA+ in the formation of various silicate oligomers, ranging from dimer to 4-ring. Calculated free-energy profiles of the reaction pathways show that the formation of a 4-ring structure has the highest energy barrier (97 kJ/mol). The formation of smaller oligomers such as dimer, trimer, and 3-ring has lower activation barriers. The TEA+ ion plays an important role in regulating the predominant species in solution via its coordination with silicate structures during the condensation process. The kinetics and thermodynamics of the oligomerization reaction indicate a more favorable formation of the 3-ring over the 4-ring structure. The results from AIMD simulations are in line with the experimental observation that TEA+ favors the 3-ring and double 3-ring in solution. The results of this study imply that the role of OSDAs is not only important for the host–guest interaction but also crucial for controlling the reactivity of different silicate oligomers during the initial stage of zeolite formation.

Pseudomonas aeruginosa is an opportunistic pathogen displaying high intrinsic antimicrobial resistance and the ability to thrive in different ecological environments. In this study, the ability of P. aeruginosa to develop simultaneous resistance to multiple antibiotics and disinfectants in different natural niches were investigated using strains collected from clinical samples, veterinary samples,and wastewater. The correlation between biocide and antimicrobial resistance was determined by employing principal component analysis. Molecular mechanisms linking biocide and antimicrobial resistance were interrogated by determining gene expression using RT-q PCR and identifying a potential genetic determinant for co- and cross-resistance using whole-genome sequencing.A subpopulation of P. aeruginosa isolates belonging to three sequence types was resistant against the common preservative benzalkonium chloride and showed cross-resistance to fluoroquinolones,cephalosporins, aminoglycosides, and multidrug resistance. Of these, the epidemiological high-risk ST235 clone was the most abundant. The over expression of the MexAB-OprM drug efflux pump resulting from amino acid mutations in regulators MexR, NalC, or NalD was the major contributing factor for cross-resistance that could be reversed by an efflux pump inhibitor. This is the first comparison of antibiotic-biocide cross-resistance in samples isolated from different ecological niches and serves as a confirmation of laboratory-based studies on biocide adapted isolates. The isolates from wastewater had a higher incidence of multidrug resistance and biocide-antibiotic cross-resistance than those from clinical and veterinary settings. Refereed/Peer-reviewed

In January 2020, we identified two SARS‐CoV‐2 infections in a familial cluster with one person coming from Wuhan, China. The complete genome sequences of two SARS‐CoV‐2 strains isolated from these patients were identical and 99.98% similar to strains isolated in Wuhan. This is genetically suggestive of human‐to‐human transmission of SARS‐CoV‐2 and indicates Wuhan as the most plausible origin of the early outbreak in Vietnam. The younger patient with a mild upper respiratory illness and a brief viral shedding, while the elderly with multi‐morbidity had pneumonia, prolonged viral shedding, and residual lung damage. Evidence of nonsynonymous substitutions in the ORF1ab region of the viral sequence warrants further studies. This article is protected by copyright. All rights reserved.

SERS (surface-enhanced Raman scattering) enhances the Raman signals, but the plasmonic effects are sensitive to the chemical environment and the coupling between nanoparticles, resulting in large and variable backgrounds, which make signal matching and analyte identification highly challenging. Removing background is essential, but existing methods either cannot fit the strong fluctuation of the SERS spectrum or do not consider the spectra’s shape change across time. Here we present a new statistical approach named SABARSI that overcomes these difficulties by combining information from multiple spectra. Further, after efficiently removing the background, we have developed the first automatic method, as a part of SABARSI, for detecting signals of molecules and matching signals corresponding to identical molecules. The superior efficiency and reproducibility of SABARSI are shown on two types of experimental datasets.

Online detection and quantification of three phosphorylated carbohydrate molecules: glucose 1-phosphate, glucose 6-phosphate, and fructose 6-phosphate was achieved by coupling sheath-flow surface enhanced Raman spectroscopy (SERS) to liquid chromatography. The presence of an alkanethiol (hexanethiol) self-assembled monolayer adsorbed to a silver SERS-active substrate helps retain and concentrate the analytes of interest at the SERS substrate to improve the detection sensitivity significantly. Mixtures of 2 μM of phosphorylated carbohydrates in pure water as well as in cell culture media were successfully separated by HPLC, with identification using the sheath-flow SERS detector. The quantification of each analyte was achieved using partial least-squares (PLS) regression analysis and acetonitrile in the mobile phases as an internal standard. These results illustrate the utility of sheath-flow SERS for molecular specific detection in complex biological samples appropriate for metabolomics and other applications.

Sclerotinia stem rot, caused by the fungal pathogen Sclerotinia sclerotiorum, is a destructive disease of canola and many other broadleaf crops. The primary inoculum responsible for initiating Sclerotinia epidemics is airborne ascospores released from the apothecia of sclerotia. Timely detection of the presence of airborne ascospores can serve as an early-warning system for forecasting and management of the disease. A major challenge is to develop a portable and automated device which can be deployed onsite to detect and quantify the presence of minute quantities of ascospores in the air and serves as a unit in a network of systems for forecasting of the epidemic. In this communication, we present the development of an impedimetric non-Faradaic biosensor based on anti-S. sclerotiorum polyclonal antibodies as probes to selectively capture the ascospores and sense their binding by an impedance based interdigitated electrode which was found to directly and unambiguously correlate the number of ascospores on sensor surface with the impedance response.

Properties of magnetic nanoparticles (MNPs) are of notable interest in many fields of biomedical engineering, especially for gene therapy. In this paper, we report a method for synthesis and delivery of MNPs loaded with DNAs, which overcomes the drawbacks of high cost and cytotoxicity associated with current delivery techniques (chemical- and liposome-based designs). 24-nm MNPs (Fe3O4) were synthesized, functionalized and characterized by analytical techniques to understand the surface properties for DNA binding and cellular uptake. The simple surface functionalization with polyethylenimine (PEI) through glutaraldehyde linker activation gave the complex of PEI-coated MNPs, resulting in high stability with a positive surface charge of about + 31 mV. Under the guidance of an external magnetic field, the functionalized MNPs with a loaded isothiocyanate (FITC) or green fluorescent protein (GFP) will enter the cells, which can be visualized by the fluorescence of FITC or GFP. We also examined the cytotoxicity of our synthesized MNPs by MTT assay. We showed that the IC50s of these MNPs for COS-7 and CHO cells were low and at 0.2 and 0.26 mg/mL, respectively. Moreover, our synthesized MNPs that were loaded with plasmids encoding GFP showed high transfection rate, 38.3% for COS-7cells and 27.6% for CHO cells. In conclusion, we established a promising method with low cost, low toxicity, and high transfection efficiency for siRNA and gene delivery.

The abundant energy provided by sunlight makes visible-light driven photoredox catalysis an attractive means of performing chemical transformations. Titanium dioxide (TiO2) and conjugated polymers are semiconducting materials that have been used as photoredox catalysts. Driving electron transfer process with photoredox catalysts and visible light has become a powerful method for achieving efficient chemical transformations. However, titanium dioxide does not readily absorb visible light, and conjugated polymers have not been extensively studied as photoredox catalysts for organic transformations. In this work, TiO2 and the conjugated polymer poly-p-phenylene (PPP) were successfully used as heterogeneous co-catalysts for the dehalogenation of some simple aryl halides using triethylamine as a sacrificial electron donor. While PPP alone exhibited some photocatalytic activity upon irradiation with visible light, the efficiency of dehalogenation was enhanced by the addition of titanium dioxide. No reaction was observed in the absence of both photocatalysts or when TiO2 was used as the sole photocatalyst. The optimum operating parameters were examined.

Current state-of-the-art deep learning-based models for human action recognition achieve impressive accuracy on benchmark datasets. However, the fact that those models are trained and tested on “clean” and high-quality input data raises a concern about their reliability under transmission artefacts and adversarial perturbations. In this work, we conduct for the first time an evaluation of the impacts of artefacts and adversarial attacks in deep learning-based human action recognition. Findings from this evaluation provide insights into the behaviors of action recognition under hostile conditions of best-effort networks.

We consider the delay control problem for multiuser opportunistic scheduling policies in wireless systems. First, the user selection behaviors of opportunistic scheduling policies are examined to highlight the delay and resource starvation issues. We then propose and analyze two schemes for delay control and starvation prevention that are both effective and flexible for use with existing scheduling policies. The first scheme, the Round-Robin Mixing (RRM) scheme, provides a simple and accurate mechanism for controlling the starvation probability in an i.i.d. environment. Based on the foundation of the RRM scheme and a small set of carefully chosen system approximations, we develop another improved scheme, the Opportunistic Bernoulli Mixing (OBM) scheme, that can support different user channel conditions and resource allocation requirements. The OBM scheme performs much closer in achievable system rate to the original non delay-controlled policy due to its flexible opportunistic delay adjustments while enabling very accurate control on user starvation probabilities. Numerical results illustrate excellent delay/performance tradeoff for the OBM scheme with negligible approximation errors for even moderately small systems.

The efficient cell transfection method is vital for various biomedical applications, such as the CRISPR-Cas9 technique. Current cell transfection methods, including lipofectamine, calcium phosphate co-precipitation, nucleofection, and viral infection are not equally efficient for various cells and have their disadvantages. In this study, a magnetic nanoparticle (MNP)-based method was introduced for delivering both FITC dye and a functional EGFP gene into easy-to-transfect HEK cells and difficult-to-transfect rat primary cortical neurons. The transfection efficacy could be controlled in both time-dependent and magnetic strength-dependent manner. This cell transfection method could have substantial potential for targeted drug delivery.

Surface enhanced Raman scattering (SERS) has become a powerful technique for trace analysis of biomolecules. The use of SERS-tags has evolved into clinical diagnostics, the enhancement of the intrinsic signal of biomolecules on SERS active materials shows tremendous promise for the analysis of biomolecules and potential biomedical assays. The detection of the de novo signal from a wide range of biomolecules has been reported to date. In this review, we examine different classes of biomolecules for the signals observed and experimental details that enable their detection. In particular, we survey nucleic acids, amino acids, peptides, proteins, metabolites, and pathogens. The signals observed show that the interaction of the biomolecule with the enhancing nanostructure has a significant influence on the observed spectrum. Additional experiments demonstrate that internal standards can correct for intensity fluctuations and provide quantitative analysis. Experimental methods that control the interaction at the surface are providing for reproducible SERS signals. Results suggest that combining advances in methodology with the development of libraries for SERS spectra may enable the characterization of biomolecules complementary to other existing methods.

Among the various types of alar deformations in Asians, alar retraction not only has the highest occurrence rate, but is also very complicated to treat because the ala is supported only by cartilage and its soft tissue envelope cannot be easily stretched. As patients' knowledge of aesthetic procedures is becoming more extensive due to increased information dissemination through various media, doctors must give more accurate, logical explanations of the procedures to be performed and their anticipated results, with an emphasis on relevant anatomical features, accurate diagnoses, detailed classifications, and various appropriate methods of surgery.

A rhinoplasty in Asians differs from a rhinoplasty performed in patients of other ethnicities. Surgeons should understand the concept of Asian beauty, the nasal anatomy of Asians, and common problems encountered while operating on the Asian nose. With this understanding, surgeons can set appropriate goals, choose proper operative procedures, and provide an outcome that satisfies patients. In this article the authors define the concept of an Asian rhinoplasty-a paradigm shift from the traditional on-top augmentation rhinoplasty to a structurally integrated augmentation rhinoplasty-and provide a step-by-step procedure for the use of Adobe Photoshop as a preoperative program to simulate the expected surgical outcome for patients and to develop a preoperative plan for surgeons.

Rhinoplasty for Asians is quite different from that of Westerners. Most Asians desire a raised nasal bridge with a projected nasal tip, similar to that of Westerners. Nevertheless, most Asian nasal bones, and upper and lower lateral cartilages are inadequately developed. This largely necessitates the use of a nasal alloplastic material such as a silicone implant, most frequently utilized in nasal cosmetic surgery for Asians. Shaping of the silicone implant is rather easy and its removal is also simple, in the case of a complication or undesired result. The disadvantage of a nasal silicone implant, like that of silicone implants of the breast, is the fibrous capsular formation, which may lead to capsular contracture. The frequently employed types of nasal silicone implant include (1) the boat type in which the silicone implant descends down to the nasal tip, (2) the L-shape in which the silicone implant further extends to the anterior nasal spine (ANS) after passing the tip, and (3) the three-quarter type for which the silicone implant extends down to the upper lateral cartilage. In conjunction with the silicone implant, the cartilages of the ear and the nasal septum are commonly used to create or lengthen tip projection. Asians generally have cartilage with inadequate anatomical development. Instead, they often have an anatomically thick fibrous fatty layer including underdeveloped superficial musculoaponeurotic system (SMAS). Patients with a thick fibrous tissue layer have a bulbous tip. This nasal tip is the area where severe capsular contracture occurs after insertion of a silicone implant. It is imperative that the surgeon properly understands the nasal anatomical characteristics of Asians, and selects an appropriate implant together with a suitable donor cartilage to attain a safe and aesthetically pleasing nose. The same principle should apply to reoperation cases; the fibrofatty layer of SMAS along with the capsular contracture must be removed or released to gain a sufficient soft tissue volume. This provides further stability to the cartilage framework.

Many East Asians experience lower eyelid bulging and discoloration, and this is seen even in young individuals. The condition is caused by an undergrowth of the maxilla and not by aging. In this condition, the orbit appears small and the infraorbital rim is hypoplastic. This inevitably causes a depressed, tired, and sad appearance. Here, the authors present techniques of volume augmentation in the lower eyelid and cheek areas to rejuvenate the midface in Asians.